Preapproval
Make sure you’re covered
Premera Blue Cross Blue Shield of Alaska offers many services and procedures that require preapproval. This process determines whether or not a service is eligible for coverage under your plan. Your in-network provider, who uses the term prior authorization, can request preapproval on your behalf.
Preapproval helps you:
- Make sure you're covered by your benefits before you have any scheduled procedure
- Save money and avoid extra costs
- Get an estimate of your out-of-pocket costs
- Avoid unnecessary services
- Avoid inappropriate or unnecessary medical treatment
Premera uses a team of experienced doctors, nurses, and healthcare analysts to determine if a medical procedure is appropriate and supported by clinical best practices.
Doctors in the Premera network can request preapproval for you
They are familiar with the process and have all of the information needed to contact Premera and request that your medical service be reviewed and approved for coverage. If your provider hasn’t already told you that the procedure is approved, be sure to ask before scheduling it.
What if your doctor doesn't request preapproval?
If your doctor provides a service that requires prior authorization and has not requested it, you may have to pay part or all of the cost, above your usual cost shares. For complete information about your plan's medical benefits and prior authorization requirements, check your benefit booklet.
Services that require prior authorization*
- Planned admission into hospitals or skilled nursing facilities
- Some inpatient surgeries
- Non-emergency ground or air ambulance transport
- Advanced imaging, such as MRIs, CT scans, and cardiac imaging
- Transplant and donor services
- Some planned outpatient procedures and surgeries
- Some injectable medications you get in a healthcare provider's office
- Prosthetics and orthotics other than foot orthotics or orthopedic shoes
- Reconstructive surgery
- Some home medical equipment
- Some drug treatments
*This is not a complete list and shows only some of the services and drug treatments that require prior authorization. Your doctor has the current list and medical information needed to request prior authorization on your behalf.
View the list of services and drug treatments requiring prior authorization for Premera Blue Cross Blue Shield of Alaska (PDF document).
Prior Authorization Metrics
Each year, to meet the CMS Interoperability and Prior Authorization Final Rule, Premera Blue Cross Alaska must post a summary of our prior authorization data on our website. This summary includes a list of all medical items and services that need prior authorization (not including drugs) and shows how many requests were approved or denied during the previous calendar year.
View 2025 Prior Authorization Metrics for Medical Items and Services (PDF document)for Premera Blue Cross Blue Shield of Alaska.
Services that do not require preapproval
- Hospital admission for childbirth and newborn care
- Emergency care
- Office visits to a primary care doctor, family doctor, or specialist
How can I track my preapproval status?
The easiest way to track the status of your preapproval request is through the website or the Premera mobile app. After you're signed in, you'll find your most recent preapproval requests. Additionally, you can:
Check preapproval status now, or download the Premera mobile app on iOS and Android.
- Track the current status and view details
- Receive notifications when there’s a change in status
- Filter by specific criteria
- View your preapproval history
Note: Premera apps support only those who get coverage through their employer and their enrolled dependents. Mobile apps don’t currently support Medicare customers, nor those who bought an individual or family plan through Washington Healthplanfinder.org or HealthCare.gov.
Pharmacy preapproval program
If you have a prescription plan benefit, some drugs must be approved for coverage through our pharmacy preapproval program.